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Student: Annabel Ludeke
Supervisors:Dr Gillian Abel, Dr Lynley Cook, Professor Philip Schluter, Ms Ramai Lord, Ms Maria Pasene
Sponsor: Partnership Health Canterbury PHO

Lay Report


Health literacy is “the way in which individuals have the ability to find, process and understand basic health information and services in order to make informed and appropriate health decisions”. This means first, a patient needs to be able to access health information such as a discussion with a doctor or nurse. Secondly, they need to be able to understand that information. And lastly, they need to be able to make a decision based on the information.

Research has shown that over half of New Zealand adults have low levels of health literacy meaning they cannot understand basic health information to make important health decisions such as choosing treatment options or starting a new medication. In addition, the lowest levels of health literacy are amongst Maori, Pacific people and high deprivation populations; the same populations that are also affected the most by long term and costly conditions such as diabetes and asthma in New Zealand.

This is a problem because research has shown people with low health literacy are less likely to use preventive services (e.g. visit a GP), less likely to self-manage their long term conditions (e.g. monitor blood sugar levels in diabetes) and are more likely to be hospitalised due to long term conditions (e.g. having later complications of diabetes).


The aim of this research was to describe practice nurses' understanding of the concept of health literacy, the problems and impact associated with low health literacy in their practice and to identify strategies they use to overcome low health literacy.


Three focus groups were conducted with fifteen practice nurses from purposively selected Christchurch general practices. The nurses were asked to discuss topics around pre-planned questions associated with health literacy in New Zealand. Their discussions were audio recorded and the transcripts were analysed to draw out important themes or topics that emerged from the analysis of the focus groups.


Four key themes were identified by practice nurses: the types of people they identify as having the biggest challenges with health literacy, difficulties with managing long term health conditions, tools that they find effective to overcome these difficulties and other issues that might have a bearing on health literacy.

1. Vulnerable Populations
The nurses identified three key populations they considered in their experience as struggling with health literacy in their practices. They found the combination of hearing impairment and the general obliging nature of the elderly as contributing factors to their challenges with understanding health information. Young people were also an identified group and the nurses attributed this to the challenges with forming trusting relationships with them. The last group identified was people where English was their second language and the challenges associated with language barriers.

2. Difficulties managing long term conditions
The nurses thought managing long-term conditions such as diabetes and asthma were a considerable challenge for people. They thought some possible reasons for this could be a combination of the complexity of the conditions and medications themselves and the lack of understanding around the use of medication as prevention for later complications.

3. Tools nurses find effective for improving health literacy
Health pamphlets and web based resources were some of the most favoured health resources the nurses used to assist their patients in understanding health information. The nurses however were concerned over the lack of availability of these resources in other languages such as Maori and Pacific. They also made valuable suggestions on how to increase the use and availability of such resources such as putting more computers with simple and reliable health resources in general practice waiting areas and public facilities such as libraries to be used by the public.

4. Other issues that have a bearing on health literacy
Nurses placed emphasis on the importance of a trusting professional relationship as central to improving health literacy and commented on specific communication skills and techniques that they identified as helpful ways to achieve this. Consistency in health information was highlighted as important for patients to understand their illnesses such as seeing the same doctor and receiving the same key messages each visit. Specific challenges nurses identified as a barrier to improving health literacy included the difficult language used in common screening questionnaires and they felt that many people, particularly when English was their second language, had considerable difficulties in understanding the questions asked of them.


The results of this study demonstrate a variety of important issues raised by nurses in New Zealand practices that can be used to improve our primary care professionals' skills around addressing health literacy. The information collected provides valuable evidence and direction for the development of new and innovative ways to improve health literacy in general practice. The study also emphasises an appreciation of addressing health literacy challenges as a vital step to improve many health outcomes in New Zealand.

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